Propofol Dopamine

There is good evidence that propofol exerts an anti-emetic effect. The mechanism of this is unclear, but animal studies have shown that it may involve depleting the area postrema of serotonin as well as direct GABA-mediated inhibition, or inhibition of dopamine release in the brain. This probably requires a plasma concentration of over 350 ng-mL-1, and therefore will be seen when propofol is used as an induction agent for very short cases, or when it is used as an infusion in longer cases. Nitrous oxide... 

The exact mechanism by which metoclopramide reduces propofol or thiopental dose requirements is unclear, but it appears to involve the blockade of dopamine (D2) receptors. 

A study in 20 patients undergoing spinal anaesthesia with tetracaine found that propofol sedation (as measured by bispectral index monitoring (BIS)) was enhanced when adrenaline was added to the intrathecal tetracaine." A study in sheep found that adrenaline, noradrenaline and dopamine decreased propofol concentrations during a continuous propofol infusion, with the result that propofol anaesthesia was reversed. This was thought to be due to increased first pass clearance of propofol secondary to increased cardiac output. It was concluded that this could be of clinical importance if propofol is used in hyperdynamic circulatory conditions induced by either catecholamine infusions or disease states such as sepsis. ... 

Myburgh JA, Upton RN, Grant C, Martinez A. Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med (200 ) 27, 276-82. 

Noninterfering alfentanil, aprotinin, atropine, bupivacaine, chlorpromazine, dalteparin, dexamethasone, diazepam, dopamine, droperidol, etomidate, fentanyl, furosemide, gallamine, haloperidol, midazolam, morphine, neostigmine, nitroglycerin, nitroprusside, oxytocin, pancuronium, pentobarbital, phenylephrine, phenytoin, pipecuronium, piperacillin, promethazine, propofol, ranitidine, succinylcholine, sufentanil, terbutaline, thiopental, vecuronium, verapamil... 

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